Sunday, July 30, 2006

Why doctor's appointments are like airplane seats

My practice has struggled to balance patient demand for appointments with availability. I've done a lot of traveling lately so have had reason to consider the way that airlines market airline seats, carefully balancing my preferences and willingness to pay against the value in their various seats.

Mid-day flights cost more than early morning flights. Exit row seats cost more than other seats (at least on Northwest.) Frequent fliers get more and earlier choice in seats than non frequent fliers. Want to change flights? That'll be $ please.

Visiting the doctor is at least as expensive as a Southwest roundtrip, and often costs as much as a first class British Airways flat-bed to London. Flyers show up an hour or two early for their trip,queue on command, and print their boarding passes at home.

My QI mavens constantly use the airline quality programs as an example of how medicine should reduce errors. Should we also adopt the pricing and seat controls that airlines use?

Some offices already shunt frequent no-show patients to a special 'alternative probationary' schedule. Isn't this a reverse frequent flier program? Concierge practices charge thousands of dollars to ensure an experience that most of us aspire to provide to our patients anyway. Isn't that a form of 'first class'? Patients in many systems can make appointments online, but I don't know of any that show doctor availability to allow patients a choice of slot. Don't you think my patients would want to know if they're the last slot in a 17 patient session (like yesterday afternoon) vs. first in a 12 patient session (like this morning)? Don't you think they'd pay different for it?

Of course payment is the kicker. We are contracturally forbidden from charging different amounts for the same service to different patients. We are also in the unusual circumstance of not knowing in advance what service will be required before we see a patient. My office visits are one kitchen renovation after another, with the same "Well I didn't know I'd find rotten joists when I agreed to retile your wall" conversations with patients.

Would you fly if you didn't know the fare, didn't know how long it would take to get there, and had no basis to judge the experience of the flight crew or seat comfort on the airplane?